Paper Example on Abdominal Pain Assessment: Focused History, Exam & Diagnoses

Introduction

It is important to take a focused history of the medical condition of the patient (Taourel, 2011). A physical examination of the patient is then performed on the patient, but since it is abdominal pain, there is no need of conducting rectal, pelvic, or corneal examinations (Perry, Potter, & Ostendorf, 2016). This is followed by an explanation of previous differential diagnoses and workup plan for the diagnoses. Based on the results of the assessment presented in the case study, it can be argued that it is supported by subjective and objective information because the signs and symptoms reported by the patient are synonymous to the kind of lifestyle led by this particular patient (Rockstraw & Wilson, 2012). In this regard, the most appropriate step is to look into the differential diagnosis of the condition described in the case study, as discussed below. The differential diagnoses discussed below describe the possible conditions that the patient could be suffering from.

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Differential Diagnoses

Cholecystitis: The pain associated with this disease is often persistent and goes for a long time (more than six hours), which is typical of this particular patient (Dye et al., 2018). The pain is often worse after taking meals, which sometimes leads to vomiting and nausea (Tilton, 2010). Even as much as this particular patient may not be having jaundice but rather mild fever, Murphy sign is highly associated with acute cholecystitis, hence making this a possible differential diagnosis.

Biliary pancreatitis: The patent's risk of developing cholelithiasis equally puts him at risk of developing biliary pancreatitis (Singh, 2011). The emerging symptoms such as vomiting, back pains, nausea, and pain after eating are symptoms associated with acute pancreatitis.

Choledocholithiasis: given that the patient is at high risk of developing cholelithiasis, he is equally at risk of developing choledocholithiasis as well. The previous experiences of abdominal pains after meals may be as a result of choledocholithiasis (Taourel, 2011). Pain in the upper quadrant of the patient as well as vomiting and nausea are also associated with the diagnosis (McNeill & American Academy of Orthopaedic Surgeons, 2013). However, the diagnosis of cholelithiasis is ruled out because the disease only affects females who are fat, fertile, and above forty years of age.

Based on the symptoms of the patient and the diagnostic differentials discussed above, it can be argued that the patient us suffering from pancreatic cancer. It means that the assessment is supported by the subjective and objective information in the case study. The information provided in the objective and subjective parts clearly defies the abdominal conditions of the patient, which subsequently justifies the diagnosis of the condition. I accept this diagnosis because the symptoms exhibited by the patient in the subjective and objective sections clearly describe the possibility of the patient suffering from pancreatic cancer.

Laboratory Evaluation

The most widely recognized laboratory facility variations from the norm in AMI are hemoconcentration, leukocytosis, raised lactic acid, and metabolic acidosis. Raised amylase and creatinine phosphokinase are likewise as often as possible utilized but are not explicit for AMI. Hyperphosphatemia and hyperkalemia are often late signs and are related to bowel fracture (Rockstraw & Wilson, 2012). Discoveries on plain abdominal radiographs are nonspecific and ought not to be used in the workups (Sailer & Wasner, 2011). Barium douches additionally have no spot in diagnosis, as this may decrease perfusion to the gut divider and cause perforation (Hawthorne & American Academy of Orthopaedic Surgeons, 2011). Leukocytosis and high lactate levels give off an impression of being available in most patients. However, these are not explicit for intense mesenteric ischemia.

Treatment

Endovascular mediation or catheter-coordinated vasodilator treatment should be prompt post-angiography. Endovascular treatment role in abdominal cramping is dubious. In this case, catheter-guided vasodilator implantation keeps on being the treatment of decision in patients without peritonitis (Keyzer & Gevenois, 2011). Catheter-coordinated thrombolysis and percutaneous angioplasty have additionally been researched in the treatment of abdominal cramping. The objective of careful consideration is the expulsion of necrotic and non-salvageable bowel and the avoidance of further localized necrosis (Cash, 2019). Stenting of the influenced courses might be used (Sharma & Rawat 2019. An exploratory laparotomy remains the highest quality level for evaluation of bowel suitability (Kapural, 2015). Multiorgan disappointment represents an extraordinary hazard in patients with abdominal cramping and mortality remains high (Seller & Symons, 2018. The most favored careful revascularization procedure in embolic abdominal cramping remains the inflatable catheter thromboembolectomy, with or without fix angioplasty of the predominant mesenteric artery (Anton, 2010). Prevention treatment ought to be used aggressively for abdominal pain; patients with atrial fibrillation ought to be begun on anticoagulants (Galvin & Bishop, 2011). Elective and convenient revascularization might be attempted in patients with constant claudication and abdominal cramping optional to atherosclerotic illness (Rockstraw & Wilson, 2012). Furthermore, patients ought to be advised to avoid smoking.

After the diagnosis, forceful IV liquid revival with crystalloids ought to be managed, beginning with volumes as high as 100 mL/kg to address any metabolic disturbances. An expansive range of anti-microbial ought to likewise be begun as right on time as would be prudent (Cham et al., 2010). If no contraindications to anticoagulation exist, remedial IV heparin sodium ought to be managed to keep up an enacted halfway thromboplastin time at double the ordinary value (In Kapural, 2015). The patient for this situation was begun on IV heparin and expansive range of anti-infection agents (Katsilambros, 2011). In an upgraded hemodynamic status, endeavors to lessen intense vasospasm in abdominal pain can be made with an IV glucagon imbuement, beginning at 1 mcg/kg/minute (Argoff & McCleane, 2009). The nearness of peritoneal signs demonstrates bowel localized necrosis and commands a crisis laparotomy (First, 2014). As noted in the patient's history, he was not on any anticoagulants on the introduction and was never a smoker.

Conclusion

The factors attributed to the causes of abdominal cramping can range from simple to life-threatening (Perry, Potter, & Ostendorf, 2016). For this reason, it is important for clinicians to have a clear knowledge about the medical history of the patient before conducting a thorough physical examination of the patents who have reported to be having abdominal pains (Morris & Fletcher, 2013). In the process, they are also expected to take consideration of vascular etiology in the stage of differential diagnosis (Merrill, 2009). The patient in the case study could be suffering from acute or chronic occlusion because he had numerous areas of stenosis in his abdomen, and the pain in those areas was equally reported to be severe (Katsilambros, 2011). However, the current diagnosis for the patient is also applicable because the symptoms are a clear representation of the diagnosis.

References

Argoff, C. E., & McCleane, G. (2009). Pain management secrets. Philadelphia, PA: Mosby/Elsevier.

Anton, C. G. (2010). Expertddx, pediatrics. Salt Lake City, Utah: Amirsys.

Cash B. (2019). A 32-Year-Old Woman with IBS: Clinical Outcomes and the use of Antibiotics. Retrieved from https://www.medscape.org/viewarticle/750961First, M. B. (2014). DSM-5 handbook of differential diagnosis. USA: American Psychiatric Publishing.

Galvin, K., & Bishop, M. (2011). Case Studies for Complementary Therapists: A collaborative approach.

Hawthorne, L., & American Academy of Orthopaedic Surgeons. (2011). Patient assessment practice scenarios. Sudbury: Jones and Bartlett Publishers.

Dye, L. R., In Murphy, C., Calello, D. P., Levine, M. D., & Skolnik, A. (2018). Case studies in medical toxicology: From the American College of Medical Toxicology.

Cham, Switzerland: Springer. International Diagnostic Course in Davos (IDKD), Holder, J., Schulthess, G. K., Zollikofer, C. L., & Foundation for the Advancement of Education in Medical Radiology. (2010). Diseases of the abdomen and pelvis, 2010-2013: Diagnostic imaging and interventional techniques. Dordrecht: Springer.

Kapural, L. (2015). Chronic abdominal pain: An evidence-based, comprehensive guide to clinical management. New York: Springer.

Katsilambros, N. (2011). Diabetic Emergencies: Diagnosis and clinical management. Chichester, West Sussex: Wiley-Blackwell.

Keyzer, C., & Gevenois, P. A. (2011). Imaging of acute appendicitis in adults and children. Berlin: Springer.

McNeill, B. A., & American Academy of Orthopaedic Surgeons. (2013). Emergency care and transportation of the sick and injured case studies. Boston: Jones & Bartlett Learning.

Merrill, R. M. (2009). Introduction to epidemiology. Sudbury, Mass: Jones and Bartlett.

Morris, F., & Fletcher, A. (2013). ABC of Emergency Differential Diagnosis. New York, NY: John Wiley & Sons.

Top of Form

Perry, A. G., Potter, P. A., & Ostendorf, W. (2016). Nursing interventions & clinical skills. St. Louis, Missouri: Elsevier.Bottom of Form

Rockstraw, L., & Wilson, L. (2012). Human simulation for nursing and health professions. New York, NY: Springer Pub. Co.Seller, R. H., & Symons, A. B. (2018). Differential diagnosis of common complaints. Philadelphia, PA: Elsevier.

Sailer, C., & Wasner, S. (2011). Differential diagnosis pocket: Clinical reference guide. Hermosa Beach, CA: Borm Bruckmeier.

Singh, N. R. (2011). NURSING: The Ultimate Study Guide. New York: Springer Pub. Co.Sharma S., & Rawat D., (2019). Case Study: 33-Year Female Presents with Chronic SOB and Cough. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK500024/Tilton, B. (2010). Wilderness first responder: How to recognize, treat, and prevent emergencies in the backcountry. Guilford, Connecticut: FalconGuides.

Taourel, P. (2011). CT of the acute abdomen. Berlin: Springer.